- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.57 / $5,367.00 / $9,512.00
| Facility | | $1,479.57 | $5,367.00 | $9,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.20 / $5,822.04 / $17,934.25
| Facility | | $1,406.20 | $5,822.04 | $17,934.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,036.57 / $2,226.73 / $3,419.63
| Facility | | $2,036.57 | $2,226.73 | $3,419.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $550.00 / $550.00
| Facility | | $550.00 | $550.00 | $550.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,066.83 / $1,386.89 / $2,757.27
| Professional | | $1,066.83 | $1,386.89 | $2,757.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.00 / $3,629.00 / $10,000.00
| Facility | | $607.00 | $3,629.00 | $10,000.00 |